Surgical Outcomes in Workman’s Compensation Patients Following Minimally Invasive 1 and 2 Level Lumbar Laminectomy

Presented at SMISS Annual Forum 2014
By Kern Singh MD
With Sreeharsha V. Nandyala BA, Alejandro Marquez-Lara MD, Islam Elboghdady , Eric Sundberg MD, Abbas Naqvi BS, Hamid Hassanzadeh MD, Anton Jorgensen MD, Andrew Park MD,

Disclosures: Kern Singh MD A; CSRS Resident Grant. B; DePuy, Zimmer, Stryker, CSRS, ISASS, AAOS, SRS, Vertebral Column - ISASS. D; Avaz Surgical, LLC, Vital 5, LLC. F; Zimmer, Stryker, Pioneer, Lippincott Williams & Wilkins, Th Sreeharsha Nandyala BA None, Alejandro Marquez-Lara MD None, Islam Elboghdady None, Eric Sundberg MD None, Abbas Naqvi BS None, Hamid Hassanzadeh MD None, Anton Jorgensen MD None, Andrew Park MD None,

Introduction:
Patients with WC claims often require lumbar decompression for work-related injuries. Despite perception biases regarding worsened outcomes in this population, the perioperative outcomes following an MIS lumbar laminectomy in WC patients have not been well characterized.

Aims/Objectives:
To compare the surgical outcomes associated with a 1 and 2 level minimally invasive (MIS) primary lumbar laminectomy in patients with and without Workman’s Compensation Insurance (WC).

Methods:
A retrospective analysis of 85 patients who underwent a 1 and 2 level lumbar laminectomy for degenerative spinal pathology between 2005-2013 was performed. Patients were separated into two cohorts based upon the primary payor status (Workman’s Compensation (WC) vs non-WC). Patient demographics, comorbidity Index (CCI), intraoperative parameters, perioperative outcomes, and postoperative complications were assessed. Statistical analysis was performed with independent sample T tests for continuous variables and Chi-square analysis for categorical data. An alpha level of <0.05 denoted statistical significance.

Results:
85 patients underwent a primary 1 and 2 level MIS lumbar laminectomy of which 16 (19.8%) carried WC insurance. The WC cohort was younger (47.5±11.7 vs 60.6±13.4) and demonstrated a lower comorbidity burden (CCI 2.09±1.97 vs 3.83±1.86) (p<0.05). Body mass index (BMI) and pre-operative visual analogue scale (VAS) scores were comparable between the study cohorts. The WC cohort comprised a greater proportion of smokers compared to the non-WC cohort. The mean procedural time was significantly reduced in the WC cohort (44.5±17.4 vs 56.4±21.5, p<0.05). However, the mean estimated blood loss (EBL), and hospital length of stay did not significantly differ as a function of the payor status. WC patients reported higher VAS scores and demonstrated greater rates of revisions/reoperations (16.7% vs 7.5%, p=0.13), but this did not reach statistical significance. In contrast, the WC cohort was associated with significantly lower rates of perioperative complications (0.0% vs 9.0%, p<0.05).

Conclusions:
WC patients who underwent an MIS lumbar laminectomy demonstrated lower rates of postoperative complications, but slightly worsened postoperative VAS scores, and revision/reoperations when compared with the non-WC cohort. These differences may be attributed to the greater physical demand in the WC patients. Regardless, MIS lumbar laminectomy is a safe and effective alternative to open surgery for the management of this challenging patient population.